Abstract
Introduction:
Maryknoll Nepal, has
been running community mental health
clinics different part of the country. The aim of
the study was to find out psychiatric morbidity of patients
attending Maryknoll
free check up clinic Simara, Bara
district of Nepal,.
Methods:
A prospective cross-sectional study
comprised of all consecutive patients attending maryknoll free check up clinic Simara,Bara district,
Nepal. All the patients attending the free clinics were taken as case. The study was performed in the
month January 2009. Demographic data
and disease profile of 87 patients attending the clinic were analyzed. The ratios and
proportions were used for statistical analysis.
Results:
Data in Simara free mental health clinic shows that the male to female ratio was 0.55 :0.44.The age group 30-39(N-25, 28.74%) followed
by age group 20-29 (N-19, 21.84%) was the commonest. The farmer were (N-49, 56.31 %) the most common visitor. The highest number of cases were
depressive disorder (N-16,18.93 %) followed by mania/BPAD (N-14, 16.09 %)
and Schizophrenia(N-12, 13.73 %).
Conclusions
Most of Patients attended Simara free mental health clinic, Simara Bara
district of Nepal are farmer of
age group 20-40 .
The commonest incidence of psychiatric illness attending the
free clinic are depressive disorder and
mania/BPAD.
Key
words: diagnosis
profile, socio-demographic characteristics, BPAD
Correspondence
Dr.C P Sedain
Department of
Psychiatry
Chitwan Medical College
Bharatpur ,Chitwan,Nepal
Email-drcpsedai@yahoo.com
Phone:9855056666
Introduction
Maryknoll
Nepal,a local NGO ,has been working in the area of mental health since 1991,
concerning mobile community mental
health clinics in different region of the country. Besides community mobile clinics it is working psychosocial rehabilitation,
public awareness programme,day care progamme and home visit programme.The
mobile health clinics tries to cover
urban as well as remote area of Nepal.
This types of programme helps that people in the remote area , where mental
health facility is not available are expected to benefit benefit. This study
was done in free mental health check up camp Simara, Bara district of Nepal, where regular monthly free check up
of mentally ill people has been started for last five year.
Studies regarding psychiatric morbidity are scare in Nepal.
The pattern of psychiatric illness has been described to similar across the
country. Regmi et al. found that
majority of cases were neurotic stress related and somatoform disorder (42.46%) followed by mood
disorder(37.23%). Still that the culture plays an important role on
morbidity pattern in the community is known as an acknowledged fact. Thus the
studies in this aspect becomes important, mainly to formulate any plan
regarding mental illness 1. There
are few studies on mental illness e.g. by Nepal et al , Wright , Shrestha and Sharma . About half of the patients in
all studies were of the age group 20-40 years and more than half were males.
However the diagnostic distribution differed among the studies. Nepal et al found that the patients mainly suffered from
neurotic and related disorders. Majority of the patients in Wright’s study were
epileptic (32℅), Shrestha found most of the patients suffering from psychosis
(63℅), while Sharma described as many as 41℅ suffered from depression. The
inconsistencies may be because of the difference in the setup, population
studied and the criteria used. Shrestha had studied the patients attending a Mental
Hospital valley; Sharma conducted the
study in private clinic setup in Pokhara, whereas Wright studied the patients
attending the health posts in a rural community. Thus despite the
inconsistencies in the diagnostic distribution, the findings in the different
setup have their own importance2. The
Quality Adjusted Life Year(QALY) losses
in primary care is highest
is in pain related physical
condition followed by mood disorder3.
Major depression
is the most common psychiatric problem seen in primary care. Prevalence figures
for major depression vary substantially between surveys 4. The reasons for increased rates among women are uncertain.
Depression is more common among the unemployed; divorced, all medical illness
and their treatment can act as non-specific stress, which may lead to mood
disorder in predisposed subject. The present study
was conducted to find out psychiatric morbidity
of patients attending
Maryknoll free check up clinic
Simara, Bara district of Nepal,.
Methods
A prospective cross-sectional study
comprised of all consecutive patients attending maryknoll
free check up clinic Simara,Bara district, Nepal. All the patients attending
the free clinics were taken as case. The study
was performed January 2009.A brief
explanation about the study was offered to the subjects and written or verbal
consent was obtained either from them or guardians. A continuous
sequential number was given to each subject and available necessary information
was kept confidential in a separate file. The socio demographic profile which
contains name, age, sex, caste, address, marital status, occupation, and other
information also filled. The diagnosis was done on the basis of I.C.D. - 10
diagnostic research criteria 5.Data from previous months also taken for make study more easy. To take
more information previous record of the
camp also studied. Data were entered in to a computer and analyzed using Statistical Package for Social Studies (SPSS)
software.
Results
A total of 87 patients were included in the study. Out of them male were 48(55.17%) and female were 39 (44.83%). Data shows highest numbers of patients were age group 30-39(N-25, 28.74%) followed by age group 20-29 (N-19, 21.84%). Data shows highest numbers of patient were married (N-59, 67.82%) and most of cases were farmer (N-49, 56.31 %).Distribution on the basis of ICD 10 diagnosis, highest number of cases were depressive disorder (N-16,18.93 %) followed by mania/BPAD (N-14, 16.09 %) and Schizophrenia(N-12, 13.73 %).Similarly seizure disorder (N-9, 10.34 %), and ,somatoform disorder (N-7, 8.05 %)., alcohol use disorder (N-6, 6.09 %).anxiety disorder (N-6, 6.09 %), conversion disorder (N-5, 5.75 %) and tension/migraine headache (N-4, 4.60%).
Table 1
DISTRIBUTION ON THE BASIS OF AGE GROUP |
|
AGE
|
N
|
|
|
|
|
%
|
|
10-19
|
12
|
13.73
|
|
20-29
|
19
|
21.84
|
|
30-39
|
25
|
28.74
|
|
40-49
|
18
|
20.69
|
|
50-59
|
7
|
8.05
|
|
60-69
|
4
|
4.58
|
|
70-79
|
2
|
2.30
|
|
TOTAL
|
87
|
100
|
Table 2
DISTRIBUTION ON THE BASIS OF SEX
|
SEX
|
CASE
|
|
|
|
NO
|
%
|
|
MALE
|
48
|
55.17
|
|
FEMALE
|
39
|
44.83
|
|
TOTAL
|
87
|
100
|
Table –3
DISTRIBUTION ON THE BASIS OF MARIETAL STATUS
|
||||||||||||||||||||||||||||
Table-4
DISTURIBUTION ON THE BASIS OF
OCCUPATION
|
OCCUPATION
|
N
|
%
|
|
|
||
|
FARMER
|
49
|
56.31
|
|
BUSINESSMAN
|
3
|
3.45
|
|
SERVICE
HOLDER
|
8
|
9.20
|
|
HOUSEWIFE
|
9
|
10.34
|
|
LABOUR
|
7
|
8.05
|
|
UNEMPLOYED
|
7
|
8.05
|
|
STUDENT
|
4
|
4.60
|
|
TOTAL
|
87
|
100
|
Table-5
DISTURIBUTION ON THE BASIS OF DIAGNOSIS
(ICD-10 DCR)
|
DIAGNODIS-ICD,10
|
MALE
|
FEMALE
|
TOTAL
|
%
|
|
DEPRESSIVE
DISORDER(F32)
|
7
|
9
|
16
|
18.39
|
|
SCHIZOPHRENIA
(F20)
|
6
|
6
|
12
|
13.73
|
|
SEIZURE
DISORDER (G40)
|
4
|
5
|
9
|
10.34
|
|
MANIA/BPAD
(F30-31)
|
8
|
6
|
14
|
16.09
|
|
ANXIETY
DISORDER (F4O-41)
|
4
|
2
|
6
|
6.97
|
|
ALCOHAL
USE DISORDER (F10)
|
5
|
1
|
6
|
6.90
|
|
SUBSTANCE
USE DISORDER (F11-19)
|
3
|
0
|
3
|
3.45
|
|
CONVERSION
DISORDER (F44)
|
0
|
5
|
5
|
5.75
|
|
DEMENTIA
(F00-03)
|
1
|
0
|
1
|
1.15
|
|
PTSD
(F43)
|
1
|
0
|
1
|
1.15
|
|
SOMATOFORM
DISORDER (F45)
|
4
|
3
|
7
|
8.05
|
|
SLEEP
DISORDER (F51)
|
1
|
0
|
1
|
1.15
|
|
MENTAL
RETARDATION (F70-79)
|
1
|
0
|
1
|
1.15
|
|
OCD(F42)
|
1
|
0
|
1
|
1.15
|
|
TENSION/MIGRAIN
HEADACHE (G43-44)
|
2
|
2
|
4
|
4.60
|
|
TOTAL
|
48
|
39
|
87
|
100
|
Discussion:
The life
style is becoming complex day by day, thus the patients consulting the
psychiatrist is increasing than previous decade. Depressive disorder is the
commonest psychiatric disorders worldwide. A review of anxiety disorder surveys in different countries
found that average lifetime prevalence
estimates of 16.6%, with women having higher rates on average6.A review of mood disorder surveys in
different countries found that lifetime
rates of 6.7% for major depressive disorder (higher in some studies, and in
women) and 0.8% for Bipolar I disorder In the United States the frequency of disorder
is: anxiety disorder (28.8%), mood disorder (20.8%), impulse-control disorder
(24.8%) or substance use disorder (14.6%)7.A
2004 cross-Europe study found that approximately one in four people reported
meeting criteria at some point in their life for at least one of the DSM-IV psychiatric disorders assessed, which included
mood disorders (13.9%), anxiety disorders (13.6%) or alcohol disorder (5.2%).
Approximately one in ten met criteria within a 12-month period. Women and younger
people of either gender showed more cases of disorder. A 2005 review of surveys
in 16 European countries found that 27% of adult Europeans are affected by at
least one mental disorder in a 12 month period 8.
Psychiatric disorder like schizophrenia, BPAD,
alcohol & drug addiction problems are also equally challenging to us. A
ten-year perspective study in Zurich, estimated the life time prevalence of major
depression is about 16 percent. The rates of depressive disorder seems to be
higher in industrialized countries9.
They are consistently increased in woman across different cultures. Nepal et al
Regmi et al reported that patients attending to psychiatric OPD of TUTH were
commonly neurotic and harboaring stress related disorder2. Similarly
Sharma’s study shows 41℅ patients were depressive disorder only. Pokhrel
et al reported that mood disorder
(35℅) followed by schizophrenia and related disorder (28℅) and neurotic and
stress related disorder (17℅) respectively3.
The percentage distribution of depressive illness reported by Sharma is similar
to our finding. Major depression is the commonest psychiatric problem seen in
primary care center. Depression is more common among the unemployed and
divorced people. If we look at our finding the depressive illness was observed
among the patient of SLC and intermediate education level. All medical
illnesses and their treatment can act as non-specific stress factor which may
lead to mood disorder in predisposed subject. Prevalence of psychiatric
disorders among general hospital population is higher than in community.
Patients with psychiatric
disorder do present with symptoms of medical illnesses. Psychiatric disorders
can be the consequence or coexist with medical illness. Many previous studies have shown that
psychiatric disorders such as depressive disorder, anxiety disorder, drug
abuse, organic mental disorders and somatoform disorder could be encountered
approximately in 20-80 percent of in-patients in any of the general hospitals worldwide.
About 20% of our patient admitted in medical and gynecology departments, especially
female patient, have some psychiatric problems in the form of mood disorder and
somatoform disorder.
Data of current study shows that the
distribution on the basis of diagnosis, highest number of cases were
depressive disorder (N-16,18.93 %) followed
by mania/BPAD (N-14, 16.09 %) and
Schizophrenia(N-12, 13.73 %).Similarly seizure disorder (N-9, 10.34 %),
and ,somatoform disorder (N-7, 8.05 %)., alcohol use disorder (N-6, 6.09
%).anxiety disorder (N-6, 6.09 %), conversion disorder (N-5, 5.75 %) and
tension/migraine headache (N-4, 4.60%). This result correlates many previous community
studies .
Conclusions
The Maryknoll free mental
health check up clinic Simara, Bara shows depressive disorder is the commonest
psychiatric disorder. Similarly other disorders include mania/BPAD, schizophrenia , seizure disorder, somatoform disorder ,alcohol use disorder, anxiety
disorder and conversion disorder. Most of the patients are farmer of age group 20-40 .
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2.
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profile in psychiatric outpatient of TUTH. Nepalese Journal of psychiatry 1999;
1: 26-33.
3.
Fernandz,A.,Sammeno.J.B.Printo-Meza.A.,Luciano,V.J.etal,
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- Smith AL,Weissman,M.M,Smith. Cross national epidemiology of major depression and bipolar disorder. Journal of American medical association. 1992;
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